Public health for occupational therapist

PUBLIC HEALTH FOR
OCCUPATIONAL
THERAPIST
(HDOT 201)
LECTURER: SIR OAK

What is health?
The World Health Organization (WHO) described health in 1948,
in the preamble to its constitution, as “A state of complete
physical, mental, and social well-being and not merely the absence
of disease or infirmity”.
As evident from the above definitions, health is multidimensional.
The WHO definition envisages three specific dimensions
(physical, mental, and Social), some other dimensions like
spiritual, emotional may also be included.

PHYSICAL HEALTH
• Physical health- is concerned with anatomical
integrity and physiological functioning of the
body.
• It means the ability to perform routine tasks
without any physical restriction. E.g.,
Physical fitness is needed to walk from place
to place.

MENTAL HEALTH
Mental Health- is the ability to learn and
think clearly and coherently. E.g., a person
who is not mentally fit (retarded) could not
learn something new at a pace in which an
ordinary normal person learns.

SOCIAL HEALTH
Social health- is the ability to make and
maintain acceptable interaction with other
people. E.g. to celebrate during festivals; to
mourn when a close family member dies; to
create and maintain friendship and intimacy,
etc.

EMOTIONAL HEALTH
• Emotional health - is the ability of expressing
emotions in the appropriate way, for example to fear,
to be happy, and to be angry.
• The response of the body should be congruent with
that of the stimuli. Emotional health is related to
mental health and includes feelings.
• It also means maintaining one’s own integrity in the
presence of stressful situation such as tension,
depression and anxiety.

SPIRITUAL HEALTH
Spiritual Health - Some people relate
health with religion; for others it has to do
with personal values, beliefs, principles
and ways of achieving mental satisfaction,
in which all are related to their spiritual
wellbeing

Different perspectives on health
1. Health is viewed as a right;
The WHO constitution states that “ . . . the
enjoyment of the highest attainable standard of
health is one of the fundamental rights of every
human being without distinction of race, religion,
political belief, economic or social condition”.

2. Others view health as an important individual
objective of material aspect i.e. as consumption
good.
3. The third view considers health as an
investment, indicates health as an important
prerequisite for development because of its
consequence on the overall production through its
effect on the productive ability of the productive
force.

Determinants of health
According to the “Health field” concept. There are four
major determinants of health or ill health.
A. Human Biology
Every Human being is made of genes. In addition,
there are factors, which are genetically transmitted
from parents to offspring. As a result, there is a
chance of transferring defective trait.

B. Environment: is all that which is external to the
individual human host. Those are factors outside the
human body. Environmental factors that could influence
health include:
I. Life support, food, water, air etc
II. Physical factors, climate, Rain fall
III. Biological factors: microorganisms, toxins, Biological
waste,
IV. Psycho-social and economic e.g. Crowding, income
level, access to health care
V. Chemical factors: industrial wastes, agricultural wastes,
air pollution, etc

C. Life style (Behavior):
It is an action that has a specific frequency, duration, and
purpose, whether conscious or unconscious. It is
associated with practice. It is what we do and how we
act.
Life style of individuals affects their health directly or
indirectly. For example:
Cigarette smoking
Unsafe sexual practice
Eating contaminated food

D. Health care organization
Health care organizations in terms of their resource in
human power, equipment, money and so on determine the
health of people.
It is concerned with
i. Availability of health service
People living in areas where there is no access to health
service are affected by health problems and have lower
health status than those with accessible health services.

ii. Scarcity of Health Services leads to inefficient health
service and resulting in poor quality of health status of
people.
iii. Acceptability of the service by the community
iv. Accessibility : in terms of physical distance, finance etc
v. Quality of care that mainly focuses on the
comprehensiveness, continuity and integration of the
health care.

Factors affecting health of a community
1. Physical Determinants -The physical factors
affecting the health of a community include:
• the geography (e.g. high land versus low land),
• the environment (e.g. manmade or natural
catastrophes) and
• the industrial development (e.g. pollution
occupational hazards)

2. Socio – cultural determinants
The socio- cultural factors affecting the health of a
community include the beliefs, traditions, and social
customs in the community.
It also involves the economy, politics and religion in the
community.
3. Community organization
Community organization include the community size,
arrangement and distribution of resources

4. Behavioral determinants
The behavioral determinants affecting health
include individual behavior and life style
affecting the health of an individual and the
community.
E.g. smoking,
alcoholism and
promiscuity

PUBLIC HEALTH
• Public health is defined as the science and art of
preventing diseases, prolonging life, promoting
health and efficiencies through organized
community effort.
• It is concerned with the health of the whole
population and the prevention of disease from
which it suffers.

Key terms in the definition
Health Promotion
• Health promotion is a guiding concept involving
activities intended to enhance individual and
community health well-being.
• It seeks to increase involvement and control of
the individual and the community in their own
health.

• Health promotion is a key element in
public health and is applicable in the
community and in all other service
settings.
• Raising awareness and informing people
about health and lifestyle factors that
might put them at risk requires teaching

The Elements of Health promotion comprises of :-
1. Addressing the population as a whole in health related
issues , in every day life as well as people at risk for
specific disability:
2. Directing action to risk factors or causes of illness or
disability;
3. Undertaking activities approach to seek out and
remedy risk factors in the community that adversely
affect health;

4. Promoting factors that contribute to a better condition of health of
the population;
5. Initiating actions against health hazards ,including communication
,education, legislation ,fiscal measures, organizational change
,community development , and spontaneous local activities ;
6. Involving public participation in defining problems ,deciding on
action;
7. Advocating relevant environmental ,health , and social policy ;
8. Encouraging health professionals’ participation in health education
and health policy.

Prevention
Prevention refers to the goals of medicine that
are to promote, to preserve, and to restore
health when it is impaired, and to minimize
suffering and distress.
There are three levels of prevention:
• Primary Prevention
• Secondary Prevention
• Tertiary Prevention

Primary Prevention
• It refers to those activities that are undertaken to prevent
the disease and injury from occurring.
• It works with both the individual and the community.
• It may be directed at the host, to increase resistance to
the agent (such as immunization or cessation of
smoking), or
• It may be directed at environmental activities to reduce
conditions favorable to reduce ADLs of the target
population.

Secondary Prevention
• It is the early diagnosis and management to
prevent complications from a disease.
• It includes steps to isolate cases and treat or
immunize contacts to prevent further epidemic
outbreaks

Tertiary Prevention
It involves activities directed at the host but also at
the environment in order to promote
rehabilitation, restoration, and maintenance of
maximum function after the disability and its
complications have stabilized.
Providing a wheelchair, special toilet facilities,
doors, ramps, and transportation services for
paraplegics are often the most vital factors for
rehabilitation.

Rehabilitation
• Rehabilitation is the process of restoring a
person’s social identity by repossession of
his/her normal roles and functions in society.
• It involves the restoration and maintenance of
a patient’s physical, psychological, social,
emotional, and vocational abilities.

• Interventions are directed towards the consequences of
disease and injury.
• The provision of high quality rehabilitation services in a
community should include the following:
1. Conducting a full assessment of people with disabilities and
suitable support systems;
2. Establishing a clear care plan;
3. Providing measures and services to deliver the care plan.

Core activities in public health
1. Preventing epidemics
2. Protecting the environment, work place ,food and water ;
3. Promoting healthy behavior;
4. Monitoring the health status of the population;
5. Mobilizing community action;

6. Responding to disasters;
7. Assuring the quality ,accessibility, and accountability
of medical care;
8. Reaching to develop new insights and innovative
solutions and
9. Leading the development of sound health policy and
planning.

ASSIGNMENT 1
Briefly discuss seven (7) likely
ethical issues and challenges in
public health.

Role of Occupational therapists in public health and health
promotion
• Public health concerns keeping people healthy and preventing ill-
health. Alongside this, health promotion is the process of working
with people to enable them to make healthy lifestyle choices in
order to improve their health.
• These two linked topics form an agenda of increasing importance
and relevance for occupational therapists, who facilitate health
promotion through working with people of all ages to enable their
participation in meaningful occupations

• Although occupational therapy practice traditionally
focuses on individuals, to evaluate the impact of
occupational therapy health promotion programs, the
profession will need to assume a greater public health
focus.
• In order to be responsive to public health issues,
Occupational Therapist will need to focus on
preventive rather than compensatory strategies.

•Expanding the focus of occupational
therapy will require changes in how
practice is delivered and how the
profession collect and report
outcomes of occupational therapy
interventions.

Public Health Focus for Occupational Therapy
• A major difference in perspective between public
health and occupational therapy is that public health
focuses on groups of people (populations), whereas
traditionally, occupational therapy focuses on
individuals.
• In addition, public health interventions are
prevention oriented.

• Thus, adoption of a public health focus requires
occupational therapy practitioners to expand their
vision of practice to address population health.
• This paradigm shift integrates the health of individuals
and communities.
• Incorporating this broad perspective requires a
reconceptualization of occupational therapy
interventions and their outcomes.

• For example, when practitioners recognize
that arthritis clients' inactivity is a health
burden for society, questions about physical
activities can be included in all assessments
of occupational performance for such
clients.

Steps for Achieving an Increased Role of OT in Health Promotion
In order to move the knowledge base of occupational therapy
research in health promotion forward, the following six (6) areas
need to be addressed:
• Identify People at Risk for Activity and Participation
Limitations.
• Design Intervention Models to treat Communities
• Examine New Models of Treatment Intensity

• Determine Measures of Population Change
• Enhance Interdisciplinary Practice
• Find Opportunities to Act Locally but Think
Nationally

1. Identify People at Risk for Activity and Participation
Limitations
• We need to identify the people with health risks,
comorbidities, occupational profiles, and performance
skills and patterns that put them at risk for activity
limitations, reduced quality of life, and health concerns.
• Doing so requires that we identify a standard set of
screening tools to evaluate these issues.

2. Design Intervention Models to treat Communities
Although there will always be a place for the
traditional face-to-face interaction, pressure to
manage health care costs and to treat clients who live
remotely are encouraging professionals to think
about alternative modes of delivering health
promotion services.

• For example, an initial assessment might be
face-to-face, but follow-up contact might be
made by telephone.
• In addition, there is increasing evidence to
suggest that peer-support models provide an
important component of health promotion
strategies.

3. Examine New Models of Treatment
Intensity
• Research in this area will examine whether
health promotion services can delay the onset
of occupational limitations and ascertain the
timing and intensity required to produce the
desired effects.

• For example, one can imagine a
situation in which clients and
occupational therapists are in contact
every few months for a brief session
to check in on progress, revise goals,
and modify intervention and health
promotion strategies.

4. Determine Measures of Population Change
• Determining the effectiveness of occupation-based
health promotion services for people will rely on both
selecting appropriate outcome measures and reporting
them as population-based statistics.
• To the extent that occupational therapy services can
create changes in health goals that are recognized as
being of public importance, the value of the profession
to the health care community will also be recognized.

In order to reflect occupational therapy concerns,
three areas of measurement are propose, namely :
(1) prevention and screening,
(2) monitoring and treatment, and
(3) outcomes.

5. Enhance Interdisciplinary Practice
Interdisciplinary health promotion can
involve traditional team members, including
physicians and physical therapists, but might
also include other professionals such as
nutritionists or chiropractors.

6. Find Opportunities to Act Locally but Think Nationally
• Although health promotion activities for people are
delivered at local clinics and practices, a challenge for
occupational therapy in the future will be to leverage the
power of national reporting systems.
• However, the impact will be only to the degree we can
identify and agree on the preventive screening,
intervention, and outcome variables and the extent to
which we will commit to reporting on them.

• In addition, OTs need to explore the
development of cooperative groups to
foster opportunities to merge datasets
across clinics and practices and health care
systems.

CONCEPT OF DISEASE
• Disease:- Abnormal medically defined changes
in the structure or functioning of the human
body.
• Ill-health/sickness:- An individual’s experience
or subjective perception of lack of physical and
or mental well-being and consequent inability
to function in social roles.

CONSEQUENCES OF DISEASE
• Three distinct and important dimensions of human experience in the
context of disease are as follows:
1. Impairment- Any loss of normality of physiological, psychological or
anatomical structure or function.
“Changes in the individuals body”
2. Disability:- Any restriction or lack of ability to perform an activity in
a manner or within the range considered normal for a human being.
‘Changes in what the individual can do and cannot do’

Cont…
3. Handicap:- The disadvantage for a given individual
arising out of impairment and disability, that limits or
prevents the fulfillment of a role that is normal
(depending on age, sex, social, cultural & factors) for
that individual as determined by society.
“changes in their relationships with the physical
and social environment”

HEALTH EDUCATION AND HEALTH PROMOTION
HEALTH EDUCATION – DEFINITIONS
• Health education may be defined as the sum total of all influences
that collectively determine knowledge, belief and behaviour related
to the promotion, maintenance and restoration of health in individuals
and communities. These influences comprise formal and informal
education in the family, in the school and in the society at large, as
well as in special content of health service activities.

• Health education is communication activity aimed at enhancing
positive health and preventing or diminishing ill health in
individuals and groups through influencing the beliefs, attitudes
and behaviour of those with power and of the community at large.
• Health education can be described as any combination of learning
experiences designed to facilitate voluntary actions conducive to
health.

HEALTH PROMOTION
• According to the WHO Charter for Health Promotion “it is a
systematic means of making it possible for people to have control
over their own health and take positive action to increasingly
improve upon their health”.
• Health Promotion therefore is basically a term used to
increasingly draw attention to the need for both educational and
political action to influence health.

NB: Health education therefore is an integral part of Health
promotion
Students should identify the
link between Health education
and Health promotion.

SOME MODELS OF HEALTH EDUCATION AND
HEALTH PROMOTION
These models are:
1.Preventive model
2.Radical-political model
3.Self-empowerment model
4.Health Belief Model

1.Preventive model
• Students should recall the levels of prevention
• The purpose of this model is to persuade you to take
responsible decisions which will help you prevent diseases at a
primary, secondary or tertiary level.
• This model has an additional purpose of encouraging you to
properly make use of the available health services to prevent
diseases at all levels.

2. RADICAL – POLITICAL MODEL
• This model requires you to get to the roots of the problem.
• Here, your attention is directed to how you can change the
community socially and environmentally through a political
action.
• Its purpose is geared towards effecting only changes in
unfavourable policies and ideologies.

3. SELF-EMPOWERMENT MODEL (SEM)
• With this model, you have the responsibility of encouraging or
helping individuals and communities to make informed choices.
This implies that you steer the people along the line which makes
them want to make a healthier choice.
• You have to provide individuals and communities with the
necessary information that will help them develop skills.

Cont…
• Helping someone to make an informed choice means that, you
are providing all the information (advantages / disadvantages)
about a particular issue or problem and the benefits of any
probable options that may arise from that information sharing.
• This model prevents the educator from acting as the ‘expert’
whilst the community members are seen as ‘lay people’.

4. HEALTH BELIEF MODEL
• The Health Belief Model (HBM) was developed as one of the
first social-cognitive models in the 1960’s in order to explain
health behavior
• Basic construct in the HBM that determine health behavior
are:
 perceived susceptibility,
 perceived severity,
 perceived barrier,

 perceived benefit,
 Perceived efficacy and
 Cues to action
 Perceived susceptibility (an individual’s assessment of their
risk of getting a condition): examples
• I am not a painter, I don’t need to protect my self against
fall.
• I am not promiscuous, I don’t need to test for HIV.

 Perceived severity (an individual’s assessment of the
seriousness of the condition, and its potential consequences).
Example: A cold isn’t a big deal, why make my white hankie
nasty.
 Perceived barriers (an individual's assessment of the influences
that facilitate or discourage adoption of the promoted
behaviour). Example: people may think I am promiscuous if I
go for HIV test.

 Perceived benefits (an individual’s assessment of the
positive consequences of the adopting the behaviour).
Example: I want to remain healthy, can condom use prevent
STIs? I will love that.
 Perceived efficacy (an individual’s self-assessment of
ability to successfully adopt the desired behavior).
Example: I am capable of doing things on my own.
 Cues to action (external influences promoting the desired
behavior) Example: This “Be bold, get tested advert on TV
is boring me, I will go for it.

OBJECTIVES OF HEALTH PROMOTION
The objectives of the health promotion strategy are, to:
1. place prevention on the agenda of policy makers;
2. create awareness on specific issues related occupational
therapy;
3. increase knowledge on rehabilitation;

4. effect positive behaviour change among community members on
their ADL;
5. develop mechanisms to involve target groups, communities in
human occupation problems in Ghana;
6. work with community members to develop and disseminate
occupational therapy messages.

Identifying HP needs and priorities
• Selecting people to benefit from HP programmes is a
complex process.
• This takes place at different levels- global, national,
regional, district, community, groups, families and
individuals.
• These people are referred to as users of HP:-ill-ness
prevention clinics, maternity homes, pest control units, EPA
etc

• Sometimes people receive health rather than using it.
Eg: receiving advice, information or health education.
• Some people are also users/clients / patients /
consumers.
Eg: patients on treatment,

• The assessment of HP needs worldwide is a part of work
of WHO, Gov’t, Depts, Health HE Authority among
others.
• All agencies and depts help in the collection of HP
needs.
• Increasingly, more agencies are undertaking joint plans.

CONCEPT OF NEED
4 kinds of needs would be discussed
 Normative need
 Felt Need
 Expressed need
 Comparative Need

Normative Need
 Defined by a professional according to his/her own
standards.
 It is based on value judgement of professional experts.
This has two problems:
i) Expert opinion may vary over what is acceptable
standard;

ii) The value and standards of the expert may differ
from that of the client.
Egs of NN:
-food hygiene regulation,
-recreational style,
- coping style,
- consuming style,
- working style , etc.

Felt Need
People identify needs according to what they want.
This may be limited by ones knowledge and awareness.
Egs:
1-A student’s FN would be to pass an exam.
2-Hypertensive patient may be conscious of what to eat
based on knowledge level.

Expressed Need
• What people say they need
• FN turned into expressed request or demand.
• Not all FN are turned into EN.

EN may conflict with ND:
-a patient may request more information from a nurse
which may be above the nurse and vise versa.
- The client’s need may not be valued by the HW/HP.
-HP expectation from the client being far fetched.

Comparative Need
• When a client within a group doesn’t receive HE like
other members in the group, that client is said to have
comparative need.
• Need , like beauty, is in the eyes of the beholder.

Identifying HP Needs
4 key areas for HP need identification.
-the boundaries of one’s job (scope)
-balance of work between being reactive and proactive
-to what extend do you put your client first?
-the usefulness of adopting a marketing philosophy

The scope
Health needs have been identified to some extent.
Think about how to make your service client-centred
and user-friendly.
Identify and respond to individual needs.
Autonomy varies according to policy of managers.
Know the boundaries of your work.

Reactive or Proactive?
Reactive:
• Responding (reacting) to the needs and demands people
make.
• Pressure from media and interest groups may introduce
bias into how needs are perceived and address.

Proactive
• Taking the initiative and working deciding on the area of
work to be done.
• It may include adding to the demands of other people if
they do not fit into existing policies and priorities.

Reactive or Proactive
Both are used in Health Promotion
The H promoter uses a client-directed approach;
 React (reactive) to clients’ expressed needs and
Use medical or behaviour-change approach to solve
them (proactive)

Putting Users’ Needs First
• Who’s needs must come first? Users’ or providers’?
• Put the needs of the user at the centre of the provision
of Health Promotion.
• Why place the user at the centre of your service?

Why users at centre?
• The user is a unique individual
• New trend of professional working at partnership with lay
people
• Emphases on improving the availability of, and access to
health promotion services eg: leisure & recreational
service, preventive health service.

Finding and Using Information
• Information gathered from local communities are used to
assess Health Promotion needs.
• Gathering and up-dating information is a continuing
activity for every Health promoter.
• Good links with the community is necessary.
• This promotes active participation of users and receivers.

Major kinds of Information
1. Epidemiological data:
Epidemiology:- The study of distribution and
determinants of diseases.
Distribution: who- age, sex, race etc
where- geographic, climate etc
when (time)- dry or wet season?
what- health problem?
why??????

Epidemiological data:-Indicate
-How many are affected by a health problem?
-How many die from the health problem?
-Who are the most at risk?

2. Socioeconomic Data
• This gives information about housing, employment,
social class, social/recreational facilities, household
amenities, heads of households etc.
• Ask for full and current figures.
• Many data are obtained from census and Annual
Reports from District/regional Directorate will show a
pattern of inequalities in health in your locality.

3. Professional Views
Views of :
 fellow Health Promoters and Educators
 Teachers
 Social workers
 Public Health Nurses
 Health Visitors
 Environmental Health Officers
• Their concerns must be treated as major health concern.

4. Public Views
Several ways of obtaining views from the public include:
 Informal discussions
 Interviews to large groups
 Focus Group discussions
 Large-scale-surveys (using questionnaire and in-depth
interview techniques)
 Identifying priority groups etc

5. Local media
Opinions and data collected through the following media
can present a picture.
 TV
 Local radio
 News papers
-give a view of any major changes in the community as
they happen.

Assessing Health Needs
Needs assessment could help you solve problems
systematically. Things to ask;
-What sort of need is it?
-Who decide that there is a need?
-What are the grounds for deciding that there is a need?
-What are the aims and the appropriate response to the need?

Setting HP priorities
To set Priorities
Analyse ‘real-life’ practices
Recognise the wide range of criteria which will affect
decisions
Remembers there are always constrains on time, resources
and energy.

PRINCIPLES OF HEALTH PROMOTION
Health promotion operates along five key principles, namely:
1.Building healthy public policy
2.Creating supportive environment
3.Re-orienting health (and related) services
4.Developing personal skills
5.Strengthening community action

BUILDING HEALTHY PUBLIC POLICY
• This principle of health promotion requires that all policies
are tailored towards promoting health.
• It requires that all policies, laws, byelaws and regulations are
regularly scrutinised and reviewed to encourage the
promotion of health actions by individuals, groups and
communities.

CREATING SUPPORTIVE ENVIRONMENT
• This principle seeks to encourage all stakeholders to
constantly bring into focus the implications of all human
centered activities.
• These activities include social, cultural, economic and
physical activities that combine to ensure and maintain
optimum health.

Cont…
The relevance of this principle is to:
• learn about the social and economic activities of the
people
• bring to the fore the health implications of such
actions
• effecting the needed behaviour changes in terms of
preventive and remedial actions.

RE-ORIENTING HEALTH (AND RELATED) SERVICES
• The need to adjust health and related services to meet the
changing demands of the clientele is the theme of this
principle.
• It requires service organizations to monitor and make
productive changes to improve access to occupational therapy
facilities.

Cont…
• This includes physical, gender and financial access.
• That is to say, service provision must take into account the
background of the people who are to enjoy the service.

DEVELOPING PERSONAL SKILLS
This involves the development of:
 personal skills of officials of the implementing agencies, its
partners as well as
 that of members of the community.

Cont…
This is necessary to ensure that:
 services are delivered correctly to complement the
provision of appropriate technology and
 community members have a proper understanding of the
correct use of facilities and are willing / able to take major
decisions to improve their health conditions.

STRENGTHENING COMMUNITY ACTION
• One of the tenets of health promotion is community
participation.
• To facilitate effective community participation,
arrangements are to be put in place to ensure that whole
communities or their representatives are involved in projects
from conceptual stages through to evaluation.

Cont…
The process of strengthening community actions therefore
depend on the extent to which they have been prepared to
 identify and express their needs,
 set objectives,
 mobilize resources,
 participate in implementation and
 evaluate the outcome of the actions taken to meet their
needs.

METHODS OF HEALTH EDUCATION
(Introduction)
• Health education helps people to make wise choices about
their health and the quality of life of their community.
• To do this, accurate information must be presented in
understandable form.
• Often many different presentations of the same facts and
ideas are needed.

BRAIN TEASER
Students should mention and explain some possible
methods of teaching used in Health Education.

1. Lecture – a formal talk on a particular subject given to
audience or a lesson or period of instruction, especially as
delivered at a college or university.
2. Discussion – a conversation, debate or argument.
3. Seminar – a group of advanced students working in a
specific subject of study under the supervision of a teacher.

4. Role-play – the assuming and performing of imaginary roles, usually as
a method of instruction, training, therapy etc.
5. Demonstration – showing explanation or demonstrating, especially a
practical lesson, explanation or exhibition.
6. Debate – a formal discussion, often in front of an audience, in which two
or more people put forward opposing views on a particular subject.

There are six (6) things to consider before choosing health education
methods.
1. How ready and able are people to change?
2. How many people are involved?
3. Is the method appropriate to the local culture?
4. What resources are available?
5. What mixture of methods is needed?
6. What methods fit the characteristics (age, sex, religion etc.) of the
target group?

There are two ways to put across health messages;
 the direct person-to-person method where you, the health
worker, are the principal communicator.
 the indirect method, in which your role is to convey to your
local audience health messages that originate elsewhere, for
example, radio and television programmes.
NB: Your success will depend on your ability to combine a
variety of methods, both direct and indirect.

COMMUNICATION IN HEALTH EDUCATION
• In everyday conversation, we may be talking just to while
away the time, explaining an issue or directing somebody.
• In the area of HE/HP you will have a purpose or objective
for communication.
• That is, to enhance people’s health status by giving them
information directed at influencing their knowledge,
attitudes, beliefs and practices for better health.

WHAT IS HEALTH COMMUNICATION ?
• In simple terms, communication is an art of giving
information to another person or group of persons.
• In Health Education, communication has specific
objectives. At the end of it all, it is required that the
objective for the communication is achieved.

Cont…
• Health communication can be depicted as a multifaceted and
multidisciplinary approach to reach different audiences and
share health-related information with the goal of influencing,
engaging and supporting individuals, communities, health
professionals, special groups, policy makers and the public
to champion, adopt, or sustain a behavior, practice or policy
that will ultimately improve health outcomes.

THE PROCESS AND STAGES OF COMMUNICATION
• In communication, the message that you give, whether verbal
or non-verbal, has to be processed through a certain basic
route.
• The key players along this route include the sender, the
message, medium of communication, and the receiver of the
message (target audience).
• The sender communicates with an objective, through an
appropriate medium and expects the receiver to give response
upon receipt of the message.

• When the message reaches the receiver, he is expected to
give a health response. This response could be instant or
will take a period of time. The response could be in the
form of making a decision, saying or doing something.
• Before the receiver gives the desired response or change in
health behaviour, the message will travel through some
stages which include:

Cont…
Reaches the senses
Gains attention
Message is understood
Is accepted
Leads to behaviour change
Leads to change in health

COMMUNICATION
• Communication is the process of passing an understandable
message from one person to another.
• Communication can also be defined as the process through
which individuals in relationships, groups, organisations
and societies create, transmit and use information to
organise with the environment and one another (Ruben,
1988)

Cont…
• It can also be explained by a simple statement, ‘who says what to
whom in what channel and with what effect’.
• The points to remember are that:
a. the message must be understandable;
b. there is a sender and a receiver;
c. there must be a means or channel of transmission;
d. the needs and interests of the receiver must be considered;
e. there must be a feedback.

Types of communication.
1. Intrapersonal communication – whereby one talks or
thinks to himself.
2. Interpersonal communication – whereby two or three
people communicate among themselves.
3. Group communication – whereby the number of people
increases.
4. Mass communication – may be a group of people using a
mass medium to communicate to large audience.

CLASSIFICATION OF COMMUNICATION
• Communication can be divided into two main groups; verbal and
non-verbal communication.
• Verbal communication is the use of speech.
• Non-verbal communication is the other means of communication
apart from speech. For example, touching, a look in the eye,
gestures, symbols, the cloth one wears and pictures.

CHANNELS OF COMMUNICATION
• The channels of communication are the use of the five senses
(touch, smell, taste, sight, hearing) to receive and interpret a
message being communicated from one person to another.
• The channels of communication are the means through which
information is received.

FACTORS THAT INFLUENCE COMMUNICATION
1.The human factor which involves both the sender and the
receiver.
2.The physical factors such as:
 the absence of communication facilities (i.e. media, or a
common language).
 distraction in the form of heat, noise etc.
 the environment e.g. crowded class.

Cont…
3. The emotional factors involve emotions such as anger, or
hatred.
4. The message itself. The code chosen must be acceptable and
understandable to all.
How then can we communicate effectively?
Students should suggest possible solutions

Cont…
In order to communicate effectively, all the above factors
must be considered whilst taking the following steps:
Get the audience’s attention –use motivation, think of the
human and physical factors.
Use a language the learner understands i.e. the type and
level of complexity. Here, think of the message

Cont…
Convince the learner to accept your views (human and
physical).
The environment must be conducive.
There must be some positive feedback. This is seen in
responses or attitudinal change.

METHODS OF COMMUNICATION
There are five main methods by which communication takes
place.
1.Verbal – use of words
2.Written
3.Visual
4.Audio
5.Action

Cont…
• In order to communicate in these various ways, we make use
of media. Media are materials through which information is
transmitted from one person to another.
NB: Students should identify the various mean/ materials by
which each of the above methods of communication uses.

BARRIERS TO COMMUNICATION
• Communication is not as smooth a process as we may
expect it.
• There are many potential barriers to communication which
must be watched and overcome if one must be an effective
communicator.
• Some of the barriers are as follows:

A. Social Barriers
i. Age difference between sender and receiver
ii. Social-economic status of the receiver (including the
cultural aspects)
iii. Language / vocabulary
iv. Competition for attention

B. Physical Body Barriers
i. Defective sight
ii.Defective hearing
iii.Infact, defection in any of the senses

C. Physical Environmental Barriers
i. Poor lighting system
ii.Poor ventilation
iii.Noise (competition for attention)
iv.Unsuitable furniture
v.Poor climatic conditions

OVERCOMING SOME OF THE BARRIERS
1.By knowing the audience.
2.The message / activity must be fitted into the time of the
situation. Deliver the message at the right time.
3.Spirit of humility may overcome the age barrier

GUIDELINES FOR CHOOSING HEALTH PROMOTION MATERIAL
• Teaching and learning material are used extensively in
health promotion programmes. But how effectively are they
used?
• The way the resources are used is as critical as the resources
themselves.
• These guidelines would be suitable for selecting materials
from existing store, or for producing new ones, for use in
health promotion activities.

1. Is it appropriate for your promotion aims?
Think about the material in terms of how you intend to use it.
2. Is it the most appropriate kind of material?
Will another medium be better because it is more flexible (eg. slides
rather than videos because they can be edited)? Will something else
be cheaper and just as effective (eg. photographs instead of a
video)? Could the real thing be used instead of being portrayed via
a teaching aid?

3. Is it relevant for the people you are working with?
• Does the material reflect the values and culture of your
clients / community?
• Does it reflect their concerns?
• Does it take into account their age, ethnic group, sex and
socioeconomic status?
• Does it reflect local practices and conditions, and health
services available?

4. Is it racist or sexist?
• All material should be non-racist. Racist material is that which
stereotypes people into racial types, attributing certain roles or
character attributes on the basis of ethnic group alone.
• All material should be non-sexist. Sexist material is that which
stereotypes men and women into certain roles or character
attributes on the basis of gender.
• Materials should reflect that we live in a multiracial society where
the roles of men and women are changing.

5. Will it be understood?
Is the material in plain language which will be readily understood?
Does it need to be produced in other languages? Are the level of
literacy or existing knowledge higher or lower than assumed?
6. Is the information sound?
Is information in the materials accurate, up-to-date, unbiased and
complete? Or does it contain half-truths, one-sided information on
controversial issues, and out-of-date or incomplete messages?

7. Does it contain advertising?
• Avoid materials that contain advertisements of drugs or
goods etc. offered by some companies.
• Company names could however be allowed on cover or
back of material.

PLANNING MEDIA
• For maximum effect, media must be well thought of, selected
or produced and used.
• It is therefore very important to plan the design and
production of any medium.
• Planning would allow you to think about the subject matter
in different ways and therefore present the information
clearly. When planning, consider the following:

1. Learner – characteristics, knowledge of subject (i.e.
previous knowledge), educational level.
2. Objectives – what you expect the person to achieve.
3. Content – information to be presented.

4. Medium itself – attributes of the medium i.e. physical
gestures medium is able to portray, e.g. colour, sound, motion
– availability of medium.
5. The learning environment – situation, group size.
6. Education method – activities to do with medium.

COMMUNITY ENTRY FOR HEALTH PROMOTION
ACTIVITIES
• Community entry – is a process of principles and techniques
of community mobilization and participation.
• It involves recognizing the community, its leadership and
people, and adopting the most appropriate processes in
meeting, interacting and working with the community.

Meeting with community leadership
1. Community has their own schedule and plans for carrying out
development activities.
2. There is the need to recognize the position and role of community
leaders so that suitable ways could be developed seeking the co-
operation and support of community members.
3. Schedule meeting times to suit the convenience of traditional leaders.

4. Observe courtesies (protocols).
5. Introduce yourself.
6. Explain the purpose of the meeting.
7. Ask permission and advice.
8. Seek ideas from contact persons / groups whose support
would facilitate your work.

Developing Community Participation
Community participation can be encouraged and supersede in
different ways. Following are some suggestions:
a. Be open about policies and plans
Be liberal with information about your policies and allow
for comments and recommendations on your plans.
Involve community representatives on planning or
management groups / teams.

b. Plan for the community’s expressed needs
When planning, allow the community to bring out its own
needs as it sees them. Consider such needs during planning.
c. Decentralize planning
Set up planning and management of programmes on a
neighbourhood basis. This would encourage public
involvement.

d. Develop joint fora
Initiate fora where community members and health staff /
technical staff can come together and discuss issues together
to clarify grey areas.
e. Develop networks
Encourage individuals or groups to come together. This
would help increase their collective knowledge and power to
change things.

f. Provide support, advice and training for community groups
Provide opportunities for lay people to develop their knowledge,
confidence and skills e.g. in leading groups, speaking in public, or
finding their way around statutory organizations and offices. This
could be accomplished through informal training / education.
g. Trainings
Provide information about health issues, details of useful local and
national organizations, leaflets, posters and books.

h. Provide help with funding and resources
Assist local groups to source for funds from governmental agencies as
well as NGOs. Also, encourage them to provide practical help from
their own resources, such as a place to meet.
i. Support advocacy projects
Support projects which enable people who are otherwise excluded
from the community to have a voice.

REFERENCES:
Challi Jira, Amsalu Feleke, Getnet Mitike (2003) Health Science
Management for Health Science Students. Lecture Note Series.
Jimma University: Faculty of Public Health.
American Occupational Therapy Association (2008). Occupational
therapy practice framework: Domain and Process, 2nd Ed.,
American Journal of Occupational Therapy, 62(6), 625-683.
Canadian Association of Occupational Therapists (2002). Enabling
occupation: an occupational therapy perspective. Author, Ottawa:
ON

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Public health for occupational therapist

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